@article {8616, title = {Associations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study.}, journal = {Soc Psychiatry Psychiatr Epidemiol}, year = {2021}, month = {2021 Jan 03}, abstract = {

PURPOSE: Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer{\textquoteright}s disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer{\textquoteright}s disease.

METHODS: We obtained a sample of non-demented participants 65~years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020.

RESULTS: Participants were on average 79~years old [standard deviation (SD) = 4], 58\% were female, and 11\% were non-white race. Mean neighborhood greenspace was 38\% (SD = 28\%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: -~0.30; 95\% confidence interval: -~0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex.

CONCLUSION: This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.

}, issn = {1433-9285}, doi = {10.1007/s00127-020-02000-w}, author = {Besser, Lilah M and Lovasi, Gina S and Michael, Yvonne L and Garg, Parveen and Hirsch, Jana A and Siscovick, David and Hurvitz, Phil and Biggs, Mary L and Galvin, James E and Bartz, Traci M and Longstreth, W T} } @article {9238, title = {Neighborhood greenspace and cognition: The cardiovascular health study.}, journal = {Health Place}, volume = {79}, year = {2023}, month = {2023 Jan 03}, pages = {102960}, abstract = {

OBJECTIVES: We examined whether greenspace measures (overall percent greenspace and forest, and number of greenspace types) were associated with clinically adjudicated dementia status.

METHODS: In a sample of non-demented older adults (n~=~2141, average age~=~75.3 years) from the Cardiovascular Health and Cognition Study, Cox proportional hazard and logistic regression analyses were used to estimate associations of baseline greenspace with risks of incident dementia and MCI, respectively, while adjusting for demographics, co-morbidities, and other neighborhood factors. We derived quartiles of percent greenness (greenspace), forest (percent tree canopy cover), and tertiles of greenspace diversity (number of greenspace types) for 5-km radial buffers around participant{\textquoteright}s residences at study entry (1989-1990) from the 1992 National Land Cover Dataset. Dementia status and mild cognitive impairment (MCI) over 10 years was clinically adjudicated.

RESULTS: We observed no significant association between overall percent greenspace and risk of mild cognitive impairment or dementia and mostly null results for forest and greenspace diversity. Forest greenspace was associated with lower odds of MCI (OR quartile 4 versus 1: 0.54, 95\% CI: 0.29-0.98) and greenspace diversity was associated with lower hazard of incident dementia (HR tertile 2 versus 1: 0.70, 95\% CI~=~0.50-0.99).

DISCUSSION: We found divergent results for different types of greenspace and mild cognitive impairment or dementia. Improved greenspace type and diversity measurement could better characterize the association between greenspace and cognition.

}, issn = {1873-2054}, doi = {10.1016/j.healthplace.2022.102960}, author = {Godina, Sara L and Rosso, Andrea L and Hirsch, Jana A and Besser, Lilah M and Lovasi, Gina S and Donovan, Geoffrey H and Garg, Parveen K and Platt, Jonathan M and Fitzpatrick, Annette L and Lopez, Oscar L and Carlson, Michelle C and Michael, Yvonne L} } @article {9532, title = {Neighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study.}, journal = {Alzheimers Dement (Amst)}, volume = {15}, year = {2023}, month = {2023 Oct-Dec}, pages = {e12484}, abstract = {

INTRODUCTION: We examined whether a combined measure of neighborhood greenspace and neighborhood median income was associated with white matter hyperintensity (WMH) and ventricle size changes.

METHODS: The sample included 1260 cognitively normal >= 65-year-olds with two magnetic resonance images (MRI; ≈ 5 years apart). WMH and ventricular size were graded from 0 (least) to 9 (most) abnormal (worsening~=~increase of >=1 grade from initial to follow-up MRI scans). The four-category neighborhood greenspace-income measure was based on median neighborhood greenspace and income values at initial MRI. Multivariable logistic regression tested associations between neighborhood greenspace-income and MRI measures (worsening vs. not).

RESULTS: White matter grade worsening was more likely for those in lower greenspace-lower income neighborhoods than higher greenspace-higher income neighborhoods (odds ratio~=~1.73; 95\% confidence interval~=~1.19-2.51).

DISCUSSION: The combination of lower neighborhood income and lower greenspace may be a risk factor for worsening white matter grade on MRI. However, findings need to be replicated in more diverse cohorts.

HIGHLIGHTS: Population-based cohort of older adults (>= 65 years) with greenspace and MRI dataCombined measure of neighborhood greenspace and neighborhood income at initial MRIMRI outcomes included white matter hyperintensities (WMH) and ventricular sizeLongitudinal change in MRI outcomes measured approximately 5 years apartWorsening WMH over time more likely for lower greenspace-lower income neighborhoods.

}, issn = {2352-8729}, doi = {10.1002/dad2.12484}, author = {Besser, Lilah M and Lovasi, Gina S and Zambrano, Joyce Jimenez and Camacho, Simone and Dhanekula, Devi and Michael, Yvonne L and Garg, Parveen and Hirsch, Jana A and Siscovick, David and Hurvitz, Philip M and Biggs, Mary L and Galvin, James E and Bartz, Traci M and Longstreth, W T} } @article {9319, title = {Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study.}, journal = {Am J Prev Med}, year = {2023}, month = {2023 Mar 05}, abstract = {

INTRODUCTION: Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease.

METHODS: The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91\% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders.

RESULTS: Among 2,939 participants, 36\% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95\% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence.

CONCLUSIONS: Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.

}, issn = {1873-2607}, doi = {10.1016/j.amepre.2023.02.001}, author = {Lovasi, Gina S and Boise, Sarah and Jogi, Siddharth and Hurvitz, Philip M and Rundle, Andrew G and Diez, Julia and Hirsch, Jana A and Fitzpatrick, Annette and Biggs, Mary L and Siscovick, David S} }